NAHQ Updated CPHQ Exam Questions and Answers by gethin

Organizations with a positive safetyculture are characterized by communications founded on mutual trust12345. This is because trust forms the basis of open and effective communication, which is essential for maintaining safety standards and procedures. In such organizations, there is a shared perception of the importance of safety, and confidence in the efficacy of preventive measures12345. This shared perception and confidence stem from the mutual trust among the members of the organization. Therefore, mutual trust is a key characteristic oforganizations with a positive safety culture.

Detailed Explanation:

To improve compliance with a corrective action plan, the QI professional should first identify the reasons for non-compliance. Conducting a root cause analysis (RCA) allows the QI professional to examine underlying factors and obstacles that may be hindering compliance. This information can then guide targeted interventions.

Option D: Determine areas of non-compliance through a root cause analysis

RCA is a structured approach to identifying underlying issues, which is critical in understanding why certain departments or individuals may not comply withcorrective actions. Once causes are identified, solutions can be tailored to address those specific barriers.

Option A: Provide disciplinary action to non-compliant departments

Disciplinary actions may not address the actual reasons behind non-compliance and can create resistance.

Option B: Provide an analysis for the Patient Safety Committee

This could be useful later but is not the first step to directly address compliance issues.

Option C: Determine if the action plan is in compliance with the national standards

Compliance with national standards is important but does not address specific compliance challenges within the organization.

Based on the provided Pareto chart of general surgery readmission causes, the most significant causes should be addressed first to have the greatest impact on reducing readmissions.

Pareto Principle (80/20 Rule): The chart illustrates that a small number of causes contribute to the majority of the readmissions. The top three causes—pain, constipation, and PCP (Primary Care Provider) unavailable—account for the most significant portion of the readmissions.

Prioritization of Interventions: By addressing these top three causes first, thehealthcare team can potentially prevent the majority of readmissions, making the intervention more efficient and effective.

Strategic Focus: Focusing on pain, constipation, and the unavailability of PCPs aligns with the principle of focusing on the "vital few" causes rather than spreading resources thinly across many less significant issues.

A medication administration workaround is the best example of a non-value-added step in the healthcare environment. Workarounds are typically informal practices that staff develop to bypass perceived inefficiencies or obstacles in standard processes. These steps often add no value to patient care and can introduce risks, making them non-value-added activities that should be identified and eliminated in the pursuit of process improvement.

Medication double checks (A): Although time-consuming, this step adds value by enhancing patient safety.

Medication reconciliation at transfer (B): This process is critical for ensuring accuracy and continuity of care, making it value-added.

Medication verbal order read-back (C): This practice is an important safety step to confirm that orders are understood correctly.

References

NAHQ Body of Knowledge: Value-Added and Non-Value-Added Activities in Healthcare

NAHQ CPHQ Exam Preparation Materials: Identifying and Eliminating Non-Value-Added Steps

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